Tag: foot orthoses

Your heel hurts! It hurts with the first steps out of bed, when you get up from a chair, and when you walk too long. I gave you advice on stretching, ice, and prescribed an anti-inflammatory medication. Often times we have to support that unstable arch of yours using custom foot orthoses. What if your pain is still there? Injecting steroids in the painful area, extracorporeal shock wave therapy, or even surgery are the traditional options remaining. But what about stem cells?

The sensationalism of advertising and the media would lead you to believe that there are stem cells available for treatment of just about anything. Is this true? Lets look at some options:

PRP (platelet rich plasma): Blood is taken from a vein and spun in a centrifuge to separate the components. One component would be the platelets and anything else that was relatively heavy circulating in your blood. Would this include stem cells? Most likely not! The platelets contain growth factors which promote healing. Injecting PRP into your heel would result in a time-release of numerous growth factors that could heal the inflammation that is your plantar fasciitis, thus making you feel better.

Amniotic membrane derived products: The amniotic membrane protects and covers a growing baby while inside the mother. The placenta is part of this marvelous structure and is delivered with the baby in normal, healthy childbirth. For this reason there is no controversy about using the placenta, as it would only be discarded if not used. Placenta blood has long been known to contain stem cells used to treat leukemia and other illnesses. Scientific studies have shown that there are cells very similar to stem cells in the placenta. If you inject cells that were taken from a placenta, your body would not reject them because they are so immature. Injecting the stem cells into an area of inflammation would in theory be able to heal the structure that is damaged or inflamed. It has yet to be proven, but seems very promising that injecting these amnion derived products into your heel would completely resolve your plantar fasciitis.

Bone marrow: Time tested and proven, the bone marrow is the ultimate source of stem cells. Unfortunately this requires a surgical procedure that can be painful and quite expensive. This is probably not a reality in treating heel pain.

Now here is the kicker. Because the scientific literature is not complete regarding using stem cells to treat plantar fasciitis, these treatments are not covered by your insurance. That means you would have to pay for them. These treatments are so new that not all physicians can provide them. At Desert Foot Surgeons, we continue to advance as treatments become available. If you have heel pain that has not responded to treatment, stem cells may be an option for you.

I love when art and science come together to make something beautiful. Wine, food, boats, and skis are just some of my favorite examples. Custom molded foot orthotics are an area I deal with everyday where art and science collide, but not everyone sees it my way. In previous articles I have taught you about unstable feet and the related problems. I have mentioned that orthotics are used to make your feet more stable and treat problems like plantar fasciitis, heel pain, flat feet, pain in the ball of the foot, and neuromas. I guess it stems from a general lack of understanding or the desperation of being in pain for so long, but lots of people seem to think that an off the shelf arch support is the same as a custom orthotic.

I’m not saying off the shelf inserts do not have their place. I prescribe off the shelf arch supports for many of my patients. These are not made to anyone’s foot in particular, and the materials used in construction are less expensive. For these reasons off the shelf inserts might not work for you. For one thing they don’t last very long because the materials are weaker and lose their shape sooner. It is not made to your foot so might not work for your problem depending what that is. Do some people get better using off the shelf arch supports? That depends on what’s wrong. At Desert Foot Surgeons, I exam your feet sitting, standing and walking. If your foot is easy to control, than an off the shelf insert might help.

Custom orthotics are an art form. First, I take a mold of your foot using plaster. It is very important to hold your foot “just right” to capture the true shape of your foot. The mold is then sent to a laboratory where it is scanned into a computer. The lab now has a model of your foot. The technician has to be an artist as well, which is why I only use one lab to make my patient’s orthotics.

Unfortunately art alone won’t make your foot stable. The science is called biomechanics and takes many years to learn. The clerk at a shoe store does not have training in biomechanics. Remember at Desert Foot Surgeons, I examine you walking, standing, and sitting. I take what I learned during your exam and write a prescription so the orthotic will control your foot. Based on my prescription, adjustments in the computer image of your foot are made and the orthotic constructed to make your foot stable.

Not everyone treats you like I do at Desert Foot Surgeons. For one thing, some molds are taken from pushing your foot into a box, onto an image scanner, or standing on a platform. The problem with these methods is that any pressure on the sole of your foot causes the muscles to spread out and the foot to change shape. Hence, the orthotic will not match your foot. A tracing, thermal print, or pressure map of your foot cannot be used to make a custom orthotic because there is no model of your foot. Standing won’t help, because I am trying to control the way you stand not accept any deformities or imbalances in your foot.

Don’t be fooled:

Have you seen any infomercials where they are selling arch supports? They always show you how much more stable the person is in the arch support by pushing their arms down. Here’s the trick. You can try it at home:

You will need a partner and a piece of paper. Keep your partner barefoot and standing with their arms straight out in front of them. Push their arms down. It should be pretty easy to move their arms. Next put the piece of paper under their heels. Again standing with their arms straight out in front. You push their arms down. Wow!! Like magic it is harder to push their arms down.

Unfortunately this is not because your friend is now stable standing on the piece of paper. This is a physiologic principle called “muscle memory”. The first time you push your friends arms down, their muscles don’t know what to expect. The second time the muscles remember what is going to happen and respond more appropriately making it harder to move the arms down. Notice in the infomercials how they never test their product first, because there is no muscle memory.

So don’t be fooled! If the arch support is cheap, it’s not custom made. If no 3-dimensional model of your foot was made, it’s not custom. If you were standing while the mold was made the orthotic is custom, it just won’t fit your foot the way I need it to in order to help you. If no exam was done with you sitting, standing, and walking, then there is no way to write the prescription. You are paying for custom orthotics. At Desert Foot Surgeons, that is exactly what you will get.

I love when art and science come together to make something beautiful. Custom foot orthotics might not look beautiful to you, but being able to create a piece of plastic that can stabilize your foot and relieve pain is pretty beautiful to me. Let me show you how I combine art and science to fix your feet at Desert Foot Surgeons.